Chapter 7
Further Evidence Related to HIV Epidemiology in MENA
This chapter covers other relevant aspects of human immunodeficiency virus (HIV) epidemiology in the Middle East and North Africa (MENA) gleaned from various sources and available data.
HIV AND SEXUALLY TRANSMITTED DISEASE CLINIC ATTENDEES, VOLUNTARY COUNSELING AND TESTING ATTENDEES, AND SUSPECTED AIDS PATIENTS HIV prevalence among sexually transmitted disease (STD) clinic attendees, voluntary counseling and testing (VCT) attendees, and suspected AIDS (acquired immune deficiency syndrome) patients has been reported for several MENA countries. Table D.1 (appendix D) lists the results of available point-prevalence surveys among these populations. Since STD clinic and VCT attendees are more likely to represent people who visited these centers because of perceived risks, the level of HIV prevalence among these populations hints at the risk of HIV exposure in a part of the population with specific identifiable risk behaviors. There are also few measures of risky behavior among these population groups. A study on STD clinic attendees in Pakistan found that 55% acquired the STD heterosexually, 11.6% homosexually, and 18.4% bisexually.1 Among STD 1
Rehan, “Profile of Men.”
clinic attendees2 and suspected AIDS patients3 in Sudan, 5.4% and 0% reported ever using a condom, 13.2% and 17.4% reported premarital and extramarital sex, 0.8% and 8.7% reported premarital sex, and 3.9% and 4.3% paid for sex, respectively. Consistently in MENA, studies report that the main source of the STD infection is sexual contact with female sex workers (FSWs), such as in the Islamic Republic of Iran,4 Kuwait,5 Pakistan,6 Somalia,7 and Sudan.8
Analytical summary These results suggest that apart from Djibouti, Somalia, and Sudan, HIV prevalence among STD clinic and VCT attendees is generally low. HIV has clearly made inroads into the heterosexual high-risk networks in Djibouti, Somalia, and Sudan. The limited prevalence in the rest of the countries is likely a consequence of the low levels of HIV prevalence in the priority groups, FSWs in particular, since the main reason for attending an STD clinic in the region is sexual contact with FSWs.
2
Ahmed, STDs. Ahmed, AIDS Patients. 4 Zargooshi, “Characteristics of Gonorrhoea.” 5 Al-Mutairi et al., “Clinical Patterns”; Al-Fouzan and Al-Mutairi, “Overview.” 6 Rehan, “Profile of Men.” 7 Burans et al., “HIV Infection Surveillance in Mogadishu, Somalia”; Ismail et al., “Sexually Transmitted Diseases in Men.” 8 Omer et al., “Sexually Transmitted Diseases in Sudanese Males.” 3
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